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Fulbright Research Topic Snapshot

Before attending the Danish Institute for Study Abroad (DIS) in the fall of 2008, I really thought I was going straight to medical school after graduating from Grinnell College. However, DIS’s Medical Practice and Policy Program helped me gain valuable insight into not only the medical field but the field of healthcare at the individual and population level. Now with a better focus and sense of what I want to pursue for a career, I am back in Copenhagen on a U.S. Department of State Fulbright Research Grant. Here is a snapshot of my research topic.

As Danish policymakers and healthcare professionals seek to ensure the extension of the welfare state and healthcare access to Muslim immigrants, they are faced with an us vs. them paradigm. Integration and identity problems both contribute to immigrant health inequalities. While studying abroad in Copenhagen in the fall of 2008, I lived in Nørrebro, a very multi-ethnic area, consisting mostly of Muslim immigrants. The experience of living in such a diversely populated area among a mostly homogeneous Danish population, constantly raised questions of immigrant integration into Danish society. Danish citizenship is based on the concept of Jus sanguinis, right of blood. This means that nationality and citizenship are determined by having an ancestor who is an ethnic citizen or a national of the state, creating ethnic homogeneity. Therefore, cultural sameness and political rights are intertwined, and “equality” is interpreted to mean two things simultaneously: “cultural similarity” and “political sameness” in regards to civic rights. With an increasingly ethnically heterogeneous society, fundamental Danish citizenship laws are being tested as the Danish identity of cultural and political sameness is challenged by refugees and immigrants.

The healthcare system of Denmark is divided into primary, secondary, and tertiary care. At the primary level, each person is assigned a general practitioner (GP) that acts as a gatekeeper, overseeing each individual’s medical history and referring them to the secondary or tertiary levels if needed. The secondary and tertiary levels are more focused on cancer or triage patients. Despite such an organized and seemingly efficient healthcare system, several studies have shown a significant difference between ethnic Dane and immigrant utilization of the healthcare system. For example, immigrants utilize the hospital emergency room service at a higher rate than ethnic Danes, although it is intended that the first interaction with the Danish health care system should be directly through the patient’s GP. However, in asking patients why they used the ER services as opposed to their GP, 45% of immigrants said it was because they could not get in contact with their GP compared to 28% of Danes. Ethnic Danes and immigrant differences in utilization of the healthcare system is a problem because without making first contact with a GP, the healthcare system is disrupted and problems such as continuity of care, medical errors, or duplication of services are more likely to occur. Interestingly enough, the United States has a similar problem as racial and ethnic minority groups are less likely to visit the doctor regularly and more likely to use emergency rooms or clinics as a regular source of care.

I hope to explore the problems of immigrant access to the Danish public health system that I think are perpetuated by problems of integration and identity. In linking integration and identity in Denmark, there are two questions that I am particularly interested in exploring in greater depth. First, what are the ways in which the Danish identity influences medical practice towards non-ethnic Danes? Secondly, what are the perceptions that non-ethnic Danes and Muslims immigrants have of their identity within the framework of the Danish culture, especially in terms of medical practice?

Those are very good questions and are definitely being considered! So far part of it is a full understanding of the benefits that they are entitled to, maybe that’s connected to identity/integration also. We will see as I begin to delve into my research project.